Is surrogacy ethical? Is outsourcing surrogacy to developing countries ethical? Though on its most fundamental level, surrogate motherhood can be interpreted as an economic transaction, the reality is far more complex due to the degree of intimacy involved. On top of the basic economics of the situation are layers of emotional complexity, rights of bodily autonomy, and unaddressed questions of women’s rights in developing countries. Each of these topics will be briefed below, and explored in greater depth on additional pages of this website.

Exploitation vs. Empowerment:
Question: Is surrogacy an act of dehumanization or empowerment for the poor women who agree to the procedure? Is this exploitation or opportunity?

Arguments: Critics of outsourcing surrogacy argue that payment for bodily services dehumanizes the surrogate mother and exploits her reproductive organs and capability for personal gain of the wealthy. Books such as Aldous Huxley’s Brave New World and Margaret Atwood’s TheHandmaid’s Tale depict dystopic worlds where child-making is performed by mass incubators (Huxley) and subjugated handservants (Atwood). Dr. John Lantos from the Center for Practical Bioethics in Kansas City is one of strongest opposers to outsourcing surrogacy: he argues that the practice only raises the risk of baby farms in developing countries, compounded by the possibility that increasing competition among clinics will compromise safety measures for these Indian women.1

Supporters of surrogacy, however, highlight the overwhelming economic opportunities for these women in light of their educational background and social circumstances. Interviews with these women generally result in optimistic correspondences, with women expressing positive outlooks on buying a home, educating their children, or paying off debt. If surrogacy contracts are transparent and surrogate mothers are protected by adequate laws, then one could argue that shifting the income generation to mothers does lead to empowerment. Evidence for this viewpoint could stem from the case of microfinance and Mohammad Yunus, where microloans to female heads of families resulting in a positive case of general community development.

Reproductive Autonomy vs. Coercion
Question: How much control do these women have over their bodies and reproductive capacities? Is there evidence of coercion by family members or in-laws?

Arguments: Feminists might argue that equal rights for women means giving women autonomy to choose for themselves, to choose their lifestyle, sexual, and reproductive freedom. With that premise in mind, telling a woman that hosting a surrogate pregnancy dehumanizes her just imposes a new form of paternalism. Why not let each woman choose for herself?

In addition, arguments based on democracy posit the need for reproductive freedom and procreative liberty, of the negative right of interference by government on matters of personal choice. Along these lines, the silence of the Indian government is in line with values of democracy, with ethical guidelines advocating for a woman’s autonomy to choose her own reproductive rights.

The counterargument to this construct dwells on the concept of choice. How much choice does a poor women in India really have? With four or five children, an absent husband, elders to care for, and limited educational opportunities, does this woman really embody the feminists’ idea of choice? How can we know whether or not her husband or intimate partner forced her to “volunteer” her services? The patrilineal marriage system in India may grant substantial influence to mother-in-laws in pressuring these women to undertake surrogacy arrangements. Currently, community stigma against surrogate mothers forces many women to live in temporary apartments or keep their pregnancies secret.2 One woman tells people that she is bearing a child for a relative.3 In this scenario, the existence of voluntary choice is debatable, if not arguably invalid.

The ethical debate on surrogacy has often looked to religious roots and cultural backgrounds in search of an answer. One of the first ancient references to infertility occurs in Genesis, when Jacob’s wife, like many of her Biblical peers, was unable to bear a child. After praying to God and begging her husband, she sends Jacob “unto” her maid and then adopts the resulting child as her own. Sara did likewise, sending Abraham to her maid Hagar, saying, “I shall obtain children by her.”4

It is often difficult to disassociate the influence of distinctly religious factors from other cultural conditions affecting women’s reproductive health. Further, religious groups often exert influence on civil authorities in matters of reproduction. Joseph Schenker has studied some of the religious differences towards ethics in surrogacy, and his findings are quite interesting. In Jewish law, a childless couple falls within the category of personal suffering and there exists a clear obligation to assist them in every permissible way, as long as no one is harmed in the process.5 The Catholic Church’s statement on assisted reproduction is clear: assisted reproduction is not accepted. The Eastern Orthodox Church supports medical and surgical treatment of infertility, and the Baptist, Methodist, Lutheran, Mormon, Presbyterian, Episcopal, United Church of Christ, Christian Science, Jehovah’s Witness, and Mennonite religions all have liberal attitudes toward infertility treatments. Islamic law encourages attempts to cure infertility, but only to the extent that IVF technologies involve the husband and wife.6

Dr. Anand Kumar, Ph.D., Chairman of Hope Infertility Clinic and Research Foundation, explores the Hindu perspective on surrogacy in his paper “Ethical Aspects of Assisted Reproduction – an Indian viewpoint.” He explains that Hindus have never seriously debated assisted reproduction because of their belief in karma, which preordains the kind of life an individual would lead after birth. There is no conflict between Hinduism and assisted reproduction, which is generally accepted as a form of treatment and not an infringement on religious beliefs.7

If done properly, Dr. Malpani of the Malphani Infertiliy Clinic believe that “surrogacy meets all three pillars of medical ethics: autonomy (allowing people to decide for themselves); beneficence (doing good); and non-maleficence (doing no harm).”8 Plausible? Perhaps. Controversial? Definitely. It is still too early to predict what effects the growing surrogacy industry will have on reproductive regulations in India.